Management Of Severe Iatrogenic Damage To Descemet's Membrane Secondary To Nd:Yag Laser: A Case Series

Two eyes of a 60-year-old female (Case 1) and one eye of an 83-year-old female (Case 2) exhibited significant central corneal edema with posterior stromal scarring due to disrupted corneal stroma and descemet's membrane. For Case 1, the corrected distance visual acuity (CDVA) on the right eye is 20/60 and 20/150 on the left, both of which were managed with topical 1% prednisolone acetate eye drops for seven months. Afterwards, an intracameral 20% sulfur hexafluoride (SF₆) gas injection was performed on the left eye, with no significant improvement. Case 2, a unilateral involvement and a CDVA of 20/100, successfully underwent descemet membrane endothelial keratoplasty (DMEK) with a 7.0 mm graft. Three months postoperatively, the patient was highly satisfied with the visual outcome after a successful Nd:YAG laser capsulotomy, which improved the CDVA to 20/50. One year after DMEK, vision further stabilized at 20/40.

In severe posterior corneal damage secondary to Nd:YAG laser treatment, DMEK may be a feasible option. Medical treatment with topical steroids and intracameral injection of 20% SF₆ were not effective.